Provider Demographics
NPI:1083233902
Name:ELITE MEDICAL GROUP PC
Entity Type:Organization
Organization Name:ELITE MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGHSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-719-5658
Mailing Address - Street 1:17748 SKY PARK CIR STE 240
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-4472
Mailing Address - Country:US
Mailing Address - Phone:828-719-5658
Mailing Address - Fax:
Practice Address - Street 1:2083 COMPTON AVE STE 202
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3416
Practice Address - Country:US
Practice Address - Phone:951-268-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty